Presentation Authors: Jose Arrambide Herrera*, Lauro Gomez Guerra, Rodrigo Romero Mata, Pedro Madero Morales, Ivan Robles Torres, Monterrey, Mexico
Introduction: Gas forming urinary tract infections are a life threatening urologic emergencies. With a reported mortality of 19-43%. These infections are caused by gram negative bacteria that ferment glucose and lactate into carbon dioxide. To date there are few studies that establish the optimal antibiotic therapy. The most common pathogens reported are Escherichia coli and Klebsiella pneumoniae. Our objective is to report bacteriology and antibiotic suseptibility of gas-forming infections treated in our hospital.
Methods: We performed a descriptive retrospective study and analized the urine cultures for uropathogens and antibiotic susceptibility of 99 patients diagnosed with emphysematous pyelonephritis and 45 patients with emphysematous cystitis confirmed by imaging studies. The antibiotic susceptibility was determined using the microdulition plate method.
Results: We analized a total of 144 urine cultures of patients with confirmed diagnosis of gas-forming urinary infection, of which 102 were positive and 42 negative. The most common pathogens isolated were Escherichia coli 71%(72/102), Enterococcus faecalis 17%(17/102), Klebsiella pneumonia 11%(11/120) and Candida albicans 11%(11/102). Extended-spectrum-Î²-lactamase-producing Escherichia coli was found in the 50%(36/72) of the E. coli cultures. The antibiotics with highest percentage of susceptibility were amikacin 67%(68/102), nitrofurantoin 67%(68/102) and ceftriaxone 35%(37/102). The antibiotics with the lowest susceptibility were amoxicillin/clavulanate 17%(17/102), sulfamethoxazole/ trimethoprim 9% (10/102) and cephalotin 3%(3/102)
Conclusions: The treatment and management of gas forming infections has changed from an aggresive aproach with surgery to a more conservative with antibiotic therapy and minimal invassion procedures. The use of the right antibiotic is essential for a better outcome. Based in our findings an antibiotic susceptible to E. coli ESBL should be considered when treating this patients with this diagnosis.